Provider Demographics
NPI:1760459416
Name:BACAY-ARUIZA MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:BACAY-ARUIZA MEDICAL ASSOCIATES INC
Other - Org Name:BACAY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-824-8419
Mailing Address - Street 1:1140 NORMAN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5900
Mailing Address - Country:US
Mailing Address - Phone:209-825-6331
Mailing Address - Fax:209-825-6351
Practice Address - Street 1:1140 NORMAN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5900
Practice Address - Country:US
Practice Address - Phone:209-825-6331
Practice Address - Fax:209-825-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAA51759261QP2300X
CAA76551261QP2300X
CANP16223261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06751ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ25328ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAF67673Medicare UPIN
CAH52706Medicare UPIN
CAZZZ06751ZOtherBLUE SHIELD PROVIDER NUMB